[Occlusion of the vertebral artery (100 personal cases)].

Occlusion of the vertebral artery is usually due to atherosclerosis. According to the site and extension of the arterial lesions 3 clinico-pathologico-angiographic situations can be encountered: segmental occlusion (proximal: V1 or distal: V3, V4), multisegmental (mainly V1-V2, sometimes V1-V2-V3) or extensive (V1 or V4). Subsequent infarctions are localized in ipsilateral cerebellar lobes and ipsilateral lateral part of the medulla oblongata; supra-medullary involvement is rare and indicates a propagation of the vertebral thrombus into the basilar artery. Cerebellar, vestibular or cerebello-vestibular strokes and Wallenberg's syndrome are the more frequent clinical disorders. They are often preceded by occipito-cervical headache. Contrary to a common belief, the vital risk in vertebral artery occlusion is not negligible. Among 160 cases, 100 of which are personal, mortality was 25%. In fact benign segmental and proximal occlusion adequately compensated, specially when isolated, must be opposed to segmental distal occlusion and extensive occlusion. Angiography and Döppler examinations localize arterial lesions and subsequent hemodynamic disorders. The treatment is often symptomatic only. Surgery of the proximal vertebral artery may in some cases be the only hope of preventing occlusion.